General Application

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General Application Form

City of Sioux Center

335 1st Avenue NW, Sioux Center IA 51250

Applicant Information:

Name:*

SSN:*

Home Address:*

College Address:

Phone Number(s):*

Date of Birth:

E-mail Address:*

Date Available:*

Desired Salary: $

Positioned Applied For:*

Are you eligible to work in the United States?*

Yes

No

Have you ever worked for this organization?*

Yes

No

Employment desired?*

Full Time

Part Time

Hours of work (per week) desired?*

Have you ever been convicted of a felony?*

Yes

No

If yes, explain:

(Number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, and sentence(s) imposed)

Education:

High School:*

Address:

Did you graduate?*

Yes

No

Degree:

College:

Address:

Did you graduate?

Yes

No

Degree:

Other:

Address:

Did you graduate?

Yes

No

Degree

Previous Employment:

Company:

Phone:

Address:

Job Title:

Supervisor:

Starting Salary: $

Ending Salary: $

Responsibilities:

From / To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

No

Company:

Phone:

Address:

Job Title:

Supervisor:

Starting Salary: $

Ending Salary: $

Responsibilities:

From / To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

No

References:

Please include Name, City, & Phone Number

Reference 1:*

Relationship:

Reference 2:*

Relationship:

I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test as a condition of employment and that continued employment may be based on the successful completion of similar tests.

I understand that the company may as part of the hiring process request an investigative consumer report from a third party entity or agency including information concerning my character, general reputation, personal characteristics, credit records, and mode of living. I may make a written request to the company o provide me with additional information regarding the nature and scope of any such report.

I understand that employment with your company is "at will" and nothing in the interview or hiring process, this application, or your company policies are intended to create an employment contract between myself and the company. Employment may be terminated by either party at any time for any reason or without notice.

In addition to completion of this form, the Lifeguard or Arena Application Form (whichever you are seeking employment for) also needs to be completed.